Pessaries are devices placed into the vagina that repair the normal anatomy of the pelvis and reduce symptoms of prolapse (Figure 2). Vaginal pessaries may be an effective method to reduce the symptoms of a prolapse, but will not be an option for everyone. A pessary may be placed to provide a uterine support and to decrease symptoms associated with prolapse. Complete uterine prolapse occurs when the uterus falls down enough so that part of the tissue extends outside of the vagina.
Uterine prolapse is caused when muscles and tissues in the pelvic floor become weak and are not able to hold up the weight of the uterus. Uterine prolapse occurs when muscles and ligaments in your pelvic floor become stretched out and weak, no longer providing adequate support to your uterus. The best thing you can do to prevent prolapsed uteruses is keep the muscles of your pelvic floor strong. A prolapsed uterus occurs when the muscles and ligaments of your pelvic floor, which hold your uterus, become weak, so much so they can no longer hold your uterus.
If the ligaments and ligaments, or the connecting tissues, are weakened or damaged, the uterus (womb) may fall into the vagina. In incomplete prolapse, The uterus can slide enough that it is partially inside of the vagina (birth canal). Other organs can prolapse in the vagina as well, including the uterus, the small intestine, and the rectum (rectocele). POP occurs when one or more of your pelvic organs–vagina, uterus, bladder, urethra, small intestine, and rectum–drop out of the way of their normal positions.
A prolapsed uterus (also called a uterine or pelvic organs prolapse) is when the uterus falls downward toward the vaginal opening. Causes of Pelvic Organ Prolapse Pelvic organ prolapse occurs when a group of muscles and tissues that normally supports the pelvic organs, called the pelvic floor, becomes weak and cannot keep the organs in position securely. Many women struggle with pelvic floor problems, including urinary incontinence and pelvic organ prolapse – when pelvic organs fall out because of weakened muscles and tissues. Prolapsed bladders are common: About 40% of women older than 50 experience pelvic organ prolapse, and about 10% require surgery to treat both pelvic organ prolapse and urinary incontinence (leaking urine).
According to the Womens Health Initiative, approximately 40 % of women between 50-79 years old will experience some type of prolapse. Common causes of uterine prolapse include vaginal birth, obesity, heavy coughing, bathroom pressures, and hormonal changes following menopause, which may harm the structures that support pelvic organs. Most cases of uterine prolapse do not need treatment; however, women who experience a prolapse outside of the vaginal opening usually want to have some type of intervention. Often, a vaginal hysterectomy may be performed concurrently with a procedure to repair uterine prolapse.
In more serious cases, women will be advised to undergo surgery to repair the damaged tissue, to insert a synthetic mesh to replace damaged tissue, or to remove the uterus completely (hysterectomy). Removal can occur via a cut (incision) made into the vagina (vaginal hysterectomy) or via the abdomen (abdominal hysterectomy). Prolapse repairs that are not hysterectomy may be done either via the vagina or via the abdomen, depending on which technique is used. Hysterectomy can be considered a treatment for certain types of pelvic organ prolapse, though the risk for prolapse in the vaginal vault (where the vaginal apex begins to fall out) can increase.
This type of prolapse can involve the front walls of the vagina (below the bladder), the back walls (below the rectum), or the top of the vagina (if you removed your uterus) — called vault prolapse. Pelvic organ prolapse is caused by weakened pelvic floor muscles, ligaments, connective tissues, and nerves, which help to support and control the rectum, uterus, vagina, and bladder. When surgery is done to treat prolapse, it is often done because the uterus (womb) is sticking out of the vagina, or sitting too low in the vagina. When the vaginal wall protrudes out to the point where the fingers are being put in (not from out the vaginal opening), prolapse is contained within.
Notice whether the fluid-filled bulb is pushing toward the front or the back of the vagina, or whether a solid cervix is sinking. Press firmly on your bottom (supine pelvic floor relaxed) for 6-8 seconds, looking for any movements toward/outwards from the vaginal wall. When a cervix or vaginal wall bulges like a golf ball or a tennis ball, it is a major prolapse. If your pelvic floor muscles felt tight and coordinated when you lifted, the prolapsed uterus is most likely from damage to the supporting ligaments and connective tissues (not muscular weakness). Uterine Prolapse Open pop-up dialog box Close Uterine Prolapse Normally, supporting ligaments and other connective tissues keep the uterus in place within your pelvic cavity.
Stages I and II of uterine prolapse, in particular, may benefit from pelvic floor muscles exercises, but these must be done properly and practiced for a sufficient amount of time to strengthen the muscles. While the following information can give you some ideas on how to perform PF exercises, it is crucial that you get professional help from a pelvic floor physical therapist if you suffer from prolapse. Have a healthcare professional educate you about how to properly isolate and train the pelvic muscles.
Or, it might be time to consider surgery if you are losing urine or stool, experiencing pain, or cannot keep a pessary on anymore. If you do not want surgery, or are a bad candidate for surgery, you can choose to put a supportive device called a pessary into the vaginal canal to hold the fallen uterus. If you have prolapsed uterus that is producing little to no symptoms, simple self-care measures can offer relief or help you avoid a prolapse that is getting worse.
In addition to incontinence, symptoms of prolapse include a heavy or pressing sensation in your lower abdomen and genitals, discomfort, and bulges that appear outside of the vagina. Straining to open the bowel gradually damages nerves that supply PF muscles, leading to a loss of bladder and bowel control. Chronic straining weakens the bladder, uterus, or bowels and can lead to POP.